膈上胸导管结扎术在食管癌切除术中的应用

目的探讨胸导管结扎术对食管癌术后乳糜胸的预防和治疗作用。方法回顾性分析我院2003年1月至2009年6月的两组共836例食管癌切除术后的乳糜胸发生情况和治疗效果。其中结扎组431例，术中常规在膈上水平整块结扎胸导管，非结扎组405例，术中未常规结扎胸导管，术后并发乳糜胸者，再次采用手术治疗。结果结扎组无术后乳糜胸发生。非结扎组术后发生乳糜胸15例（3．7％），治愈13例（86．7％），死亡2例（13．3％），1例死于呼吸功能衰竭，1例死于多器官功能衰竭。结论食管癌切除术中常规结扎胸导管可有效预防术后乳糜胸的发生。膈上胸导管结扎法稳妥有效。食管癌术后并发乳糜胸应积极手术治疗。

Application of thoracic duct mass ligation in the esophagectomy for carcinoma

Objective To explore the effect of thoracic duct mass ligation on the prevention and treatment of the postoperative chylothorax in the esophagectomy for carcinoma. Methods A retrospective study was undertaken in 836 patients who underwent esophagectomy for carcinoma of the esophagus from Jan. 2003 to June 2009. Some patients（ n = 431 ）were subjected to the conventional ligature of the thoracic duct in the esophagectomy, while others（ n = 405 ）underwent non -ligature of the thoracic duct. The occur- rence of postoperative chylothorax was compared treated with thoracic duct mass ligation. Results between the two groups. Postoperative chylothorax were No postoperative chylothorax occurred in the group of the routine ligature of the thoracic duct, whereas 15 cases of postoperative chylothorax（3.7%, 15/405） were developed in the group of non - ligation. The leakage was successfully treated by repeated thoractomy with the thoracic duct mass ligation in the patients developing chylothorax. Two patients died （ 13.3% ）, one from the respiratory failure,and the other from the general failure. Conclusion Routine prophylactic thoracic duct mass ligation in the esophagectomy for carcinoma is safe and effective in the prevention and treatment of postoperative chylothorax.